A technological knockout for head injuries?

Published: Summer 2013

Obvious concussions are easy to identify. You don’t have to be a doctor to recognize the symptoms: confusion, memory loss, nausea, balance problems. It’s like watching one of those viral videos of someone staggering through a field sobriety test. You just know.

The problem is that athletes who suffer head injuries don’t always show such signs — or they try to hide them to keep playing. Dr. James Moriarity, Notre Dame’s chief sports medicine physician, says injured players often give little, if any, immediate indication of a concussion.

“Where it gets tough,” he says, “is if somebody comes off the field, maybe with a headache but no memory loss, [and] they answer questions appropriately.”

Based on experience treating head trauma and knowledge of an individual’s normal behavior, doctors such as Moriarity, a 26-year veteran of the Notre Dame sidelines, can make informed judgments in the moment. Tests known as the King-Devick and the Sport Concussion Assessment Tool 2 also help medical personnel evaluate a player’s cognitive functions and, if they diagnose a concussion, to determine when to clear the athlete for competition.

But there’s been no technological equivalent of a Breathalyzer for borderline cases. Notre Dame researchers are developing the closest thing yet — a sort of field severity test — that could inform a doctor’s diagnostic judgment.

Christian Poellabauer, an associate professor of computer science and engineering, and his colleagues, Professor Patrick Flynn and graduate student Nikhil Yadav, have created a high-tech concussion test that’s as simple as talking into an iPad. For the last two years, boxers in the Bengal Bouts have served as research subjects.

Months before the bouts, all the competitors take the test. Over about 40 seconds, they read aloud 15 words that pop up on the screen. This establishes a norm used when the same test is conducted after each fight.

Within a minute the app, called Contect, analyzes the voice from that second test and calculates the likelihood that the boxer has suffered a concussion. Results from this year’s Bengal Bouts are still being analyzed, but in 2012 the tool flagged all nine boxers out of 125 competitors whom the medical staff independently found to have concussions.

Official diagnoses are based on medical exams, which the boxers must pass after each bout to be cleared to fight again. Even if proven viable over time, Contect is not meant to be the final word on an athlete’s condition, but it will provide more data. “It’s a first-line-of-defense kind of tool,” Poellabauer says, emphasizing it will require “many more trials” before it can be used reliably in the field. “Our goal,” he adds, “is to help find the [injuries] that are under the radar.”

Early detection is important, because suffering more than one concussion, particularly before existing symptoms have cleared, increases the possibility of permanent damage.

Besides the advantage of being administered and evaluated at ringside or on a football sideline, Contect tests for nuances in the voice that athletes can’t fake. Although the King-Devick test, for example, can be taken on the sideline, results are based on a timed reading of numbers; athletes might deliberately read slowly during baseline testing, lowering the bar they have to clear in the event of an injury. The Contect algorithm is based on scientific literature linking vocal frequencies to brain function, Poellabauer says. Injured people, no matter how macho, cannot disguise their acoustic symptoms.

The subtleties that Contect can tease out make it potentially useful for identifying head trauma in soldiers or early signs of diseases such as Parkinson’s and Alzheimer’s. But the suicides of former NFL players such as Dave Duerson ’83, who acquired the brain disease chronic traumatic encephalopathy from years of football-related head trauma, have drawn attention to the long-term risks posed by contact sports.

Moriarity notes that scientific understanding of concussions has not advanced much in recent years despite the welcome increase in vigilance. “Right now,” he says, “our tolerance for letting somebody go back following a head injury is a heck of a lot more limited.”

Athletes appear more cautious, too. Alex Oloriz ’13, this year’s Bengal Bouts president and a finalist in the 168-pound division, described a change in sparring over his four years that he attributes in part to heightened awareness of head injuries. Once endurance contests that could become “brawls,” practice sessions now tend more toward technical fine-tuning, he says.

Still, the sport is unavoidably violent. As Moriarity puts it, every boxer experiences head trauma. That brutal fact presents related research opportunities to improve the prevention and treatment of brain injuries.

In 2012, for instance, Oloriz was part of a group fitted with high-tech mouthpieces that measured the force of punches and the rotation of the head. Boxers also wore headbands under their padded helmets to help the medical staff quantify the g-forces boxers experience in the ring. The preliminary analysis was a testament to the confounding facts of concussion science.

“What we’ve found,” Moriarity explains, “was that it really didn’t seem to matter how hard you were hit or how much of a rotation you got in terms of how you responded to it,” a finding supported by similar studies with football players. It may be that some people are better built to take a blow to the head without injury than others.

“[A] concussion might actually be a protective mechanism,” Moriarity says. “If we find that kids are getting concussions from relatively low levels of trauma, does that alert them that they shouldn’t be doing this?”

Jason Kelly, a former sports columnist for the South Bend Tribune, is an associate editor of the University of Chicago Magazine. Email him at jasonkelly545@gmail.com.